Covid-19: Straight talk from those on the front lines

This isn’t my usual letter to you, but these aren’t usual times. I have a more soulful post coming to you soon, but I wanted to share some information from some of my friends who are still on the front lines of healthcare.

Some of you know that I am a board certified PA and have been for 22 years.

There is a lot of misinformation out there right now and I thought hearing from my associates, who have put this in pretty plain English, might be helpful.

I learned from them, and I hope you do too. This is not meant to induce any fear, only a clear seeing and deep acceptance of what is, and then discerning the wisest action to take.

I’ll let them tell you in their own words.

From my friend, critical care PA Elizabeth:

“I was a critical care physician assistant for 14 years prior to transitioning to emergency medicine. I have resuscitated many members of our community. I have intubated them, coded them, saved them and lost them with an exceptional team of providers. I have worked without enough staff, critical care/ICU beds, or supplies needed to do our job. This was all before coronavirus.

I assure you that we do not have the staff, space, or supplies to do what needs to be done to save lives if we do not stop what we are doing RIGHT NOW. You have been told to stay home and if you must go to the stores for essentials then go out and get them. You have been told to stay 3-6 feet away from each other. Instead, people are having play dates, sleep overs, standing in lines at stores with no masks/gloves for things you may not need, hanging out with friends, and making jokes about this. YOU HAVE BEEN TOLD TO STAY HOME SO DO IT.

We do not have the staff to handle the spike in the curve that you are selfishly causing by not listening to what health officials are telling you, BUT ALSO YOU ARE PUTTING OUR HEALTH PROFESSIONALS AT GREATER RISK. THE HARDER OUR NURSES, DOCTORS, RESPIRATORY THERAPISTS, CNAs, NPs, PAs, HOSPITAL HOUSEKEEPING, AND EVERYONE ELSE ARE WORKING, THE MORE LIKELY THEY WILL BECOME SICK. They will accidently break protective gear procedure, their immune systems will break down, their mental health will be destroyed.

Before you post online, read about ITALY. EDUCATE YOURSELF. Listen to what the DOH is telling you. Before you go out you should ask, “ Is this visit out so important that someone in my family or someone else’s could die if I bring corona home with me”. That is really the question you should be asking before you go out. Most of us already believe that there is community spread locally. Please be smart, educate yourself, make the right choices about social distancing, watch the updates, and DO YOUR BEST TO KEEP US ALL HEALTHY. STAY HOME IF YOU CAN.”

From a wonderfully respected colleague Dr. Julie Silver, Harvard Medical School

Please take the time to read the whole thing, it is an important summary about COVID19, flattening the curve and what will happen if we don’t take strict precautions now:

“It has been years since I have posted anything. As a physician at Harvard Medical School, I have amazing access to the best information and resources for #Covid19. I know people are getting a lot of information, and not all of it is accurate. My friend Dr. Reem Ghalib summarized the situation in one of the best social media posts to date on this topic (copied/pasted below). Please read what she has to say and share with your loved ones, friends, and colleagues. Urge people to be calm and logical in their decision making. Err on the side of caution. Re the info below–note that “coronavirus” is used generically to mean the specific strain Covid 19. I will apologize in advance for not responding to comments as work is very hectic right now:

Dear Friends,

So much confusion, misinformation and denial is bouncing around on social media about the coronavirus that I thought I would try to explain, in plain language, why the experts see this as such an emergency.

You will see the claim online that this virus is a lot like the viruses that cause colds, and that if you get it, it will probably just seem like a bad cold and you are very unlikely to die. Depending on who you are, these statements are probably true. But they are incomplete, and the missing information is the key to understanding the problem.

This is a coronavirus that is new to the human population, jumping into people late last year from some kind of animal, probably at a wildlife market in Wuhan, China. It is related to the viruses that cause colds, and acts a lot like them in many ways. It is very easy to transmit through the respiratory droplets that all of us give off. But nobody has ever been exposed to this before, which means nobody has any immunity to it.

The virus is now moving explosively through the human population. While most people will recover, about 20 percent of the people who catch it will wind up with a serious disease. They will get pneumonia that causes shortness of breath, and they may need hospitalization.

Some of those people will get so sick that they cannot be saved and will die of the pneumonia. The overall death rate for people who develop symptoms seems to be 2 or 3 percent. Once we have enough testing to find out how many people caught the virus but did not develop symptoms, that might come down to about 1 percent, optimistically.

This is a large number. It is at least 10 times higher than the mortality rate for the seasonal flu, for instance, which in some years kills 60,000 or 70,000 Americans. So just on that math, we could be looking at 600,000 or 700,000 dead in the United States. But it gets worse.

Older people with existing health problems are much more vulnerable, on average. The mortality rate of coronavirus among people over age 80 may be 15 or 20 percent. It appears to have 7 or 8 percent mortality for people aged 70 to 79. Here is the terrible part: If you are a healthy younger person, you can catch the virus and, without developing serious symptoms yourself, you can pass it along to older people. In other words, as the virus spreads, it is going to be very easy to go out and catch it, give it to your grandmother and kill her, even though you will not die yourself. You can catch it by touching a door knob or an elevator button.

Scientists measure the spread of an epidemic by a number called R0, or “R naught.” That number is calculated this way: for every person who develops the illness, how many other people do they give it to before they are cured (or dead) and no longer infectious? The R0 for coronavirus, in the absence of a control strategy, appears to be a number close to 3 – maybe a bit higher or lower, but in that ballpark. This is an extremely frightening number for such a deadly disease.

Suppose you catch the virus. You will give it to 3 other people, and they will each give it to three others, and so forth. Here is how the math works, where you, the “index case,” are the first line:

243

729

2,187

6,561

19,683

59,046

177,147

531,441

1,594,323

4,782,969

14,348,907

So, in just 15 steps of transmission, the virus has gone from just one index case to 14.3 million other people. Those 15 steps might take only a few weeks. The index person may be young and healthy, but many of those 14 million people will be old and sick, and they will likely die because they got a virus that started in one person’s throat.

The United States is not at this point yet, with millions infected, as best we can tell. We don’t really know, because our government has failed us. We are many, many weeks behind other countries in rolling out widespread testing, so we don’t really have a clue how far the thing has spread. We do know that cases are starting to pop up all over the place, with many of the people having no known exposure to travelers from China, so that means this virus has escaped into our communities.

We do not have approved treatments, yet. We do not have a vaccine. The only tool we really have now is to try to slow down the chain of transmission.

This can be done. In other words, R0 is not fixed – it can be lowered by control measures. If we can get the number below 1, the epidemic will die out. This is the point of the quarantines and the contact-tracing that you are hearing so much about in the news. But the virus is exploding so fast that we will not have the labor available to trace contacts for much longer, so we have to shift strategies. This has already begun, but we are not doing it fast enough.

It is now likely that the majority of Americans will get this virus. But slowing it down is still crucial. Why? Because the healthcare system has limited resources. We only have about a million hospital beds in America. We have well under a million ventilators. If millions of Americans get sick enough to need treatment, we will have a calamity on our hands. What will happen is a form of battlefield triage, where the doctors focus on trying to treat the young and allow the older people to die.

This is not theoretical. It is already happening in Italy, where people over 65 are being left alone on hospital gurneys to suffocate to death from pneumonia. They basically drown in their own sputum. There is simply not enough medical capacity to take care of them. The United States appears to be about two weeks behind Italy on the epidemic growth curve.

What do we need to do now? We need to cancel all large gatherings – all of them. You have probably seen that the N.B.A. has postponed the rest of its season. Other sporting events, concerts, plays and everything else involving large audiences in a small space – all of it needs to be canceled. Even if these events take place, do not go to them. No lectures, no plays, no movies, no cruises – nothing.

Stay at home as much as possible.Stay out of restaurants. I would cancel any travel that is not absolutely essential. Work from home if you possibly can. You may have to go buy groceries and medicine, of course, but make the trips quick and purposeful. Wash your hands assiduously after you have been in public places, for a full 20 seconds, soaping up thoroughly and being sure to get between the fingers. Sunlight and alcohol will kill the virus.

And please stop passing around statements on social media claiming that the situation is not serious or is being exaggerated. This is a national crisis, and conveying misinformation to your friends and family may put their lives in danger.”

If you like charts, graphs and statistical models, here is an article you might want to check out, or this post that has been shared over 121,000 times.

Thank you for reading and for doing everything in your power to flatten the curve by being meticulous about social distancing, if not for you, for our incredible healthcare workers and for our elders.

We only have one chance to do the right thing.

The time to take action is right now.

I’ll be back in touch soon about some opportunities I see in all of this, how we can stay calm during this crisis, and how we can create something even more beautiful on the other side.

May all beings be safe and well! Please share this with anyone you think might need to hear it.

much love,